Evaluation of the Do Not Resuscitate Orders at a Community Hospital

Stolman, Cynthia J.; Gregory, John J.; Dunn, Dorothea; Ripley, Barbara

doi:10.1001/archinte.1989.00390080103023

Cited by 54 publications

(8 citation statements)

References 20 publications

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“…21 Prior studies have made clear that making such decisions is strongly associated with patients' clinical and demographic characteristics. 3,7,[9][10][11][22][23][24][25][26][27][28][29] Th ese relationships are unlikely to be directly causal. Rather, older age and greater functional limitations, for example, are likely to be markers of preferences for less aggressive care at the end of life.…”

Section: Discussionmentioning

confidence: 99%

Variation in Decisions to Forgo Life-Sustaining Therapies in US ICUs

Quill

Ratcliffe

Harhay

et al. 2014

Chest

122

116

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Section: Discussionmentioning

confidence: 99%

Variation in Decisions to Forgo Life-Sustaining Therapies in US ICUs

Quill

Ratcliffe

Harhay

et al. 2014

Chest

122

116

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“…6,7 Inappropriate withholding of life support is a grave error because up to 60% of patients with a DNR order survive to hospital discharge. 8 Procedure-specific DNR order forms attempt to promote accurate communication and more comprehensive documentation of DNR status. 2,5 In a validation study of a procedure-specific DNR order form, 5 we observed improved communication among caregivers, but total congruence of understanding of all elements of the DNR order between attending physicians, residents, and nurses existed for only 48% of patients.…”

Section: Discussionmentioning

confidence: 99%

“…15 Previous investigations have demonstrated the resistance of physicians to interventions designed to improve documentation of the rationale for a DNR status and the physician's discussion of the DNR order with the patient and family. 2,8,16 The computer-generated DNR communication sheet provided an unanticipated benefit by assisting physicians in identifying mistakes in DNR order entry. Errors were noted in 10% of the DNR orders during period 3 after attending physicians reviewed the DNR communication sheet.…”

Section: Commentmentioning

confidence: 99%

Communicating Do-Not-Resuscitate Orders With a Computer-Based System

Heffner

Barbieri²,

Fracica³

et al. 1998

Arch Intern Med

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“…The reality, however, is that patients are not always able to participate in their own resuscitation decisions when these decisions are triggered, for example, after an acute medical event. [5][6][7] A further complication is that surrogate decision-makers have been found to incorrectly predict patients' end-of-life treatment preferences in a third of cases. 8 Moreover, other studies have demonstrated that doctors are unable to predict their patients' resuscitation preferences.…”

Section: Introductionmentioning

confidence: 99%

Why do older people refuse resuscitation? A qualitative study examining retirement village residents’ resuscitation decisions

Ramages

Cheung

2018

Psychogeriatrics

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Background: There is a dearth of qualitative research on resuscitation preferences of older New Zealanders. The aim of this study was to investigate the resuscitation preferences of older New Zealanders in a retirement village or residential care setting, as well as the reasons for these preferences. Methods: This study had 37 participants from two retirement villages in Auckland, New Zealand. Participants were interviewed about a hypothetical case vignette about cardiopulmonary resuscitation, and then they completed a semi-structured interview. Interviews were subsequently transcribed and analyzed by two independent researchers using thematic qualitative methodology. Results: The majority of the participants (n = 25, 67.6%) decided against resuscitation, 10 (27.0%) wanted resuscitation, and 2 (5.4%) were ambivalent about their resuscitation preferences. Three main themes emerged during the data analysis regarding participants' reasons for deciding against resuscitation: (i) the wish for a natural death; (ii) advanced age; and (iii) a realistic awareness about the consequences of resuscitation. Responses related to the third these had three subthemes: (i) reduced quality of life; (ii) loss of personal integrity and sense of existence; and (iii) concern that resuscitation could result in unnecessary costs or a burden on others. Among participants who preferred resuscitation, two main themes emerged regarding their reasons for wanting resuscitation: (i) the wish to prolong a good quality of life; and (ii) unrealistic expectations of resuscitation. Conclusions: Older people in this study were able to make reasoned decisions about resuscitation based on balancing their subjective estimations of quality of life and the presumed consequences of resuscitation. It is important therefore to educate older adults about the potential outcomes of resuscitation and explore (and document) their reasoning when discussing resuscitation preferences so their wishes can be respected.

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Evaluation of the Do Not Resuscitate Orders at a Community Hospital

Cited by 54 publications

References 20 publications

Variation in Decisions to Forgo Life-Sustaining Therapies in US ICUs

Variation in Decisions to Forgo Life-Sustaining Therapies in US ICUs

Communicating Do-Not-Resuscitate Orders With a Computer-Based System

Why do older people refuse resuscitation? A qualitative study examining retirement village residents’ resuscitation decisions

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